More than half of people in a recent survey said they find it difficult to find the lowest-cost option for their medications, and they don’t trust that they are paying the lowest price.
Formulary Watch
Latest News
All News
Advertisement
Lynavoy is used to treat cholestatic pruritus, an extreme itch that affects almost 90% of patients with primary biliary cholangitis.
Prime Therapeutics’ IntegratedRx gives prescribers and pharmacists a shared, real-time view of patient records, improving patients’ experience and better outcomes.
Two surveys from West Health and Gallup find that healthcare affordability is a significant economic issue that affects nearly every aspect of life.
Abarca Health CEO Jason Borschow says making prior authorization frictionless will require trusted frameworks for exchanging data and decision-making that both payers and providers align on.
David Cordani is retiring after 17 years in the CEO role. he will join the board of directors as executive chair.
Sharon Faust, of Navitus Health Solutions, said in an interview that employers, health plans and manufacturers must work together to manage costs and access for patients taking GLP-1 medications.
Leaders of the smaller PBMs say they’ve always been transparent, pass-through companies, and complying with the new law’s reporting requirements is not a heavy lift.
Senators Elizabeth Warren and Josh Hawley have introduced bipartisan legislation that addresses a system that they say adds costs and leaves independent doctors and pharmacists unable to compete.
Advertisement
During an investor call, CVS Health executives said the new legislation requiring changes in PBM business practices was manageable, but they expressed some concern about CMS’s Medicare advanced rate notice.
A recent analysis shows that most products subject to price reduction under the Inflation Reduction Act have achieved substantial returns on investment by the time of negotiations.
PBM reform has finally made its way through Congress and was signed into law by President Donald Trump. Here are seven things you need to know about the law.
Cigna reported 11% revenue growth for 2025. Company executives focused on several key issues in its call with investors: its settlement with the Federal Trade Commission, a transformation announced last year to move to a rebate-free model in pharmacy benefits, and a focus on patient affordability.
Express Scripts agreed to overhaul its business model, ensuring patients pay the lowest available price for medications and reimbursing community pharmacies based on actual costs.
CMS announced 15 drugs for Medicare price negotiations under the IRA, representing $27 billion in spending and treating conditions such as diabetes, cancer, and autoimmune conditions. Here are three insights on the list from industry experts.
During an investor call, UnitedHealth Group executives talk about the steps it has taken to increase transparency, use technology to reshape its healthcare delivery and address how it adapting to financial pressures across its Medicare, Medicaid, and Affordable Care Act businesses.
In a Q&A, Jeffrey Hogan, managing director and co-founder of Judi Group, talks about the importance of identifying hidden costs and contract conflicts of healthcare vendors.
Legislation reforms pharmacy benefit managers by mandating price transparency, eliminating certain compensation models, and providing CMS funding to enforce contract terms.
Lawmakers from both parties grill insurance companies over claims denials, prior authorization delays, and vertical integration.
Judi Group brings together top benefits specialists, ERISA attorneys, actuarial analysts, and technologists to assess risk and protect fiduciary integrity across vendors and solutions.
Medicare’s recently released drug pricing models GLOBE and GUARD use international price benchmarks to generate government rebates but experts say they are unlikely to reduce costs for patients.
Beginning this month, PBMs in California must prioritize health plan interests over their own, and CVS Caremark’s CalPERS contract includes $250 million in performance guarantees.
The PBM association also appointed Brendan Buck chief communications officer. Both Marin and Buck begin Jan. 20, 2026.
Lytenava, an ophthalmic bevacizumab formulation to treat patients with wet age-related macular degeneration, received yet another FDA complete response letter. The agency is asking for confirmatory efficacy data beyond existing NORSE trial results.
The results of an American Society of Health-System Pharmacists survey shed some light on what is on the minds of pharmacy leaders at health systems.
Advertisement
Advertisement
Trending on Managed Healthcare Executive
1
1,700 sites closed, 77,000 fewer children received PEPFAR-supported treatment after PEPFAR disruption | IAS 2026
2
CGM prescribed by primary care lowers A1C and acute care use in diabetes patients
3
Health Begins at Home: Why Housing Has Become a Strategic Priority for Managed Care
4
Could uveitis in patients with melanoma being treated with immune checkpoint inhibitors be a good thing?
5